One-staged in situ embolization combined with surgical resection for eloquence protection of AVM: technical note

Wang, Mingze; Qiu, Hancheng; Cao, Yong; Wang, Shuo; Zhao, Jizong

doi:10.1007/s10143-019-01137-w

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…Besides, it has been proposed for neurological protection. Han et al ( 91 ) and Wang et al ( 84 ) reported their experience of applying the staged or hybrid paradigms to protect the neurological function of bAVMs in brainstem and eloquence, respectively. In their procedures, the nidus adjacent to eloquence had been embolized through the prior endovascular manipulations.…”

Section: Resultsmentioning

confidence: 99%

“…Hybrid-modality treatment is the up-to-date paradigm, which combines endovascular and microsurgical procedures in a single stage without any interval ( 81 , 139 ). It has been proved to be feasible in treating bAVMs, especially the eloquent ones ( 80 , 84 ). The hybrid-modality treatment possessed the advantages of endovascular and microsurgical manipulations, and expanded the operative techniques.…”

Section: Resultsmentioning

confidence: 99%

“…Most of them were utilized for the treatment of high-grade bAVMs, which were difficult to cure by any monotherapy, or to exceed the indications of it ( 76 , 78 , 83 , 158 , 263 ). It could be applied to bAVMs in low grades as well, for the specific purpose of protecting neurological functions and decreasing intraoperative risks ( 84 , 132 , 133 ). However, no extra benefit had been observed in the low-grade lesions ( 131 ).…”

Section: Resultsmentioning

confidence: 99%

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Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

et al. 2021

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Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas.Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association.Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III.Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

et al. 2021

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“…In recent years, neurosurgery has gradually begun to use hybrid surgery technology [1,2]. At present, complex operation is mainly used in the treatment of complex cerebral arteriovenous malformations [3]. Before the surgery, the main blood supply branches are blocked or embolized, the branches in the malformation are reduced, and the bleeding in the separation is limited [4].…”

Section: Introductionmentioning

confidence: 99%

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

2021

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Background We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation. Methods Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled. The hybrid surgery protocol included “angiographic diagnosis, surgical resection, and intraoperative angiographic evaluation” and “angiographic diagnosis and embolization, surgical resection, and intraoperative angiographic evaluation”. The patients were randomly stratified into intensive care group and routine care group. After surgery, intensive or routine care was provided, and the prognosis of patients was evaluated, with a subsequent comparative analysis. Results A total of 109 cases were divided into the routine nursing group (n = 54 cases) and intensive nursing group (n = 55 cases). There were no significant differences between the two groups in baseline data before surgery. Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group (5.5% vs. 18.5%, P=0.039) with pulmonary infection and lower extremity venous thrombosis (5.5% vs. 24.1%, P=0.006). The average hospital stay in the intensive nursing group was 14.4 ± 5.78 days, which was significantly lower than that in the routine nursing group (19.3 ± 6.38 days, P=0.013). At 3 months’ follow-up after surgery, the Generic Quality of Life Inventory-74 (GQOLI-74) dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group (P=0.017 and 0.023, respectively). Conclusions Intensive postoperative nursing can improve the safety of patients after hybrid surgery, reduce the postoperative complications and the average length of hospital stay, and improve the quality of life of patients.

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“…However, previous studies have shown that despite the high rate of poor outcomes for high-level unruptured AVMs, the associated mortalities are likely lower than untreated patients (4,5). Recently, several studies proposed that the intraoperative embolization strategies might benefit the subsequent surgical resection procedure and the long-term neurofunctional outcomes for complex cerebral AVMs (6)(7)(8)(9)(10)(11)(12)(13)(14). In this study, we assessed the prognostic difference between hybrid and surgical resection alone strategy in obliterating SM grade III-V AVMs, and we further explored the intraoperative embolization degree and resection portion surrounding the single-stage hybrid strategy.…”

Section: Introductionmentioning

confidence: 99%

Single-Stage Combined Embolization and Resection for Spetzler-Martin Grade III/IV/V Arteriovenous Malformations: A Single-Center Experience and Literature Review

Chen

et al. 2020

Front. Neurol.

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Background and Purpose: This study sought to identify the efficacy and intraoperative operational details of single-stage combined embolization and microsurgery strategy for Spetzler-Martin (SM) grade III/IV/V arteriovenous malformations (AVMs). Methods:The authors retrospectively reviewed consecutive SM grade III/IV/V AVMs who underwent hybrid procedures and surgical resection alone procedures from January 2016 to February 2018. Outcomes [modified Rankin Scale (mRS)] were compared between hybrid group and surgical resection alone group in ruptured or unruptured subgroup. Factors associated with long-term disability were assessed using multivariable logistic regression analyses.Results: A total of 100 AVM patients (47 corrected using hybrid procedures whereas 53 by surgical resection alone) were evaluated. After a mean follow-up of 2.3 ± 0.6 years, we found no difference in long-term prognosis and incidences of disability rates between these two strategies. However, the hybrid strategy offers significant advantage in accelerating the resection process [ruptured (P = 0.000); unruptured (P = 0.002)]. In the analysis of risk factors, excessive embolization (Grade C, 60-100%) was significantly associated with long-term disability in the hybrid cohorts (P = 0.041; odds ratio, 24.000; 95% CI, 1.140-505.194), and involvement of deep perforating arteries was the significant predictor of long-term disability in the surgical resection alone cohort (P = 0.025; odds ratio, 15.389; 95% CI, 1.412-167.66). In the subgroup analysis of the hybrid cohort, moderate embolization (Grade B, 30-60%) was recommended because of the low risk ratio of major intraoperative bleeding (P = 0.033).Conclusions: Single-stage combined embolization and resection is an efficient strategy for the treatment of SM grade III/IV/V AVMs. Although the long-term outcomes were similar to surgical resection alone, the hybrid strategy had obvious advantages of shorter resection. In the hybrid technique, moderate embolization was recommended, and excessive embolization might be detrimental to the subsequent microsurgical resection. Chen et al. Hybrid Strategy for AVMs Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT04136860.

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One-staged in situ embolization combined with surgical resection for eloquence protection of AVM: technical note

Cited by 9 publications

References 25 publications

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

Single-Stage Combined Embolization and Resection for Spetzler-Martin Grade III/IV/V Arteriovenous Malformations: A Single-Center Experience and Literature Review

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